Military Medicine最新文献

Bacterial translocation from normal oral flora, such as Aggregatibacter spp., can rarely lead to endocarditis, bloodstream infections, and abscesses. We present a case of an immunocompetent active duty service member with a hepatic abscess from a presumed routine dental hygiene cleaning with Aggregatibacter kilianii bacteremia. Aggregatibacter kilianii is a relatively novel species, closely related to the well-reported Aggregatibacter aphrophilus but genetically distinct. This appears to be one of the first described cases of a hepatic abscess caused by this species.

Dermatofibrosarcoma protuberans (DFSP) is a rare, soft tissue sarcoma often misdiagnosed as a scar, particularly in patients with darker skin tones. This delay in diagnosis can lead to adverse outcomes, especially in the military population, where early detection and treatment are crucial for maintaining fitness for duty. We present a case of a 26-year-old active duty female with a 2-year history of a gradually enlarging lesion on her right buttock. Initially diagnosed as dermatitis or a scar, the lesion persisted and was ultimately diagnosed as DFSP through biopsy and histopathological examination at our military treatment facility. This case underscores the diagnostic challenges of diagnosing DFSP in underrepresented populations, the importance of considering DFSP in the differential diagnosis of scar-like lesions, and the need for increased awareness among military providers to facilitate timely diagnosis and intervention.

Introduction: Tension pneumothorax is the third leading cause of potentially survivable death in the prehospital, combat setting. Identification of the presence of a pneumothorax before tension physiology develops remains challenging in this setting. We conducted an early developmental pilot study to determine if unprocessed raw radio frequency (RF) data from a single-crystal ultrasound array could fill this gap.

Materials and methods: We prospectively enrolled sus scrofa models as part of a medical education training program with intentional induction of pneumothorax. We obtained thoracic imaging using Clarius (clinical) and Verisonics (research) devices, only the latter of which could provide RF data from the entire probe array. We assembled RF time histories into a feature vector and used principal components analysis to extract features with the greatest variance. We examined linear discriminant analysis (LDA) and logistic regression as classifiers.

Results: Six sus scofa were included in the final analysis. The Clarius system yielded single image-based RF-traces per acquisition, which did not prove useful for further analysis. From the Verisonics system, we obtained 49 acquisitions pre-pneumothorax and 41 acquisitions pneumothorax, each of which contained 20 image frames and raw RF data for all scanlines. A vast majority of the RF signal variance was contained in the first PC, although all but the last PC contained at least >0.3% of the total variance. Only PC0 mean is statistically significant between pre- and post- groups (P = .0472). A bivariate logistic model using PC0 and PC8 (P = .184) correctly predicted 5 of 6 animals in each condition (83.3%), with 1 animal misclassified from each condition. The LDA analysis yielded only 1 linear discriminator feature, which showed a difference in the means between groups (P = .0161). This single LD used as input to a univariate logistic model yielded equal prediction accuracy to the previous classifier (83%, 1 misclassified per group), with animal 3 pre and animal 1 post misclassified by this reduced feature, and animal 2 post being nearly misclassified.

Conclusions: In this pilot study, we were able to determine a potential signal for the diagnosis of pneumothorax using RF data. Our findings will aid in the development of low-power devices to detect pneumothorax.

Introduction: This service evaluation (SE) sought to determine if United Kingdom Armed Forces (UKAF) personnel diagnosed with pericoronitis were treated in line with Defence Guidance and Policy documents. United Kingdom Armed Forces Policy states pericoronitis should be managed in a proactive manner and all mandibular third molars (M3M) should be considered for extraction after a single episode of infection. An additional objective was to establish waiting times for M3M referrals to both Tier 2 (practice based) and 3 (hospital) providers.

Materials and methods: Five hundred forty-five attendances for urgent care with the diagnosis of pericoronitis, between February and March 2019, were sampled via identification of the pericoronitis read code on the common records system used in Defence Primary Healthcare Dental. Following application of inclusion and exclusion criteria, 269 patient electronic records were assessed. Patient demographics alongside the frequency of symptoms and ultimate management of their M3M were recorded and analysed using Microsoft Excel. Trends between referral waiting times and patient history were sought.

Results: Operative intervention, in line with UKAF policy, was considered for 27% (n = 73) of the patients after urgent attendance. One hundred ninety-six patients (73%) did not have a proactive approach to their pericoronitis treatment and therefore did not meet UKAF Policy. 36% (n = 96) of patients had their M3M extracted, part extracted (Coronectomy), or an operculectomy in the 5 years following the urgent attendance. 64% (n = 173) of the sample met the National Institute for Health and Care Excellence Technology Appraisal third molar guidance (NICE TA1 guidance). The waiting times were significantly (P value < .001) longer for patients referred to Tier 3 services compared to those accessing care at Tier 2. No geographic variation in services (P value .095) was noted and there was no significant difference in waiting times at Tier 3 when those hospitals with a military Oral and Maxillofacial Surgery consultant were compared to those with no military consultant in post (P value .21).

Conclusions: United Kingdom Armed Forces personnel diagnosed with pericoronitis were not treated in line with UKAF Policy. Most patients suffered recurrent episodes of pain where the M3M was left in situ, even when a conservative treatment plan adopted. Waiting times for Tier 2 care were significantly shorter than Tier 3. This SE would support a recommendation of increased access to Tier 2 services to improve the dental readiness of UKAF personnel.

Introduction: Certain army recruits entering basic training may be at heightened risk of injury. It is unknown if risk factors for lower limb injuries could be identified upon entry to basic training for New Zealand Army recruits. This study investigates if personal, lifestyle and physical performance characteristics reported at entry to training could identify recruits who go on to sustain a lower limb musculoskeletal injury during New Zealand Army basic training.

Materials and methods: Recruits' baseline personal (age, sex, and BMI), lifestyle (history of smoking and previous injury) and physical performance characteristics (2.4 km timed run outcome, ankle range of motion using the weight-bearing dorsiflexion lunge test and lower limb dynamic control using the Y Balance Test) were collected at entry to basic training. Backwards stepwise logistic regression analyses were undertaken to determine if baseline variables predicted the occurrence of an injury during basic training and to determine the optimal model of prediction. Significance was set to 0.10. This study was approved by Commander of TRADOC NZDF February 2012 and from Griffith University Human Research Ethics Committee May 2012 (PES/36/11/HREC).

Results: In total 248 recruits, 228 males and 20 females, were eligible to participate in the study. Forty-six (18.5%) recruits had missing data thus, 202 (81.5%) remained for analysis. There were 114 recruits who reported one or more injuries, and 88 recruits reported no injury. Two variables were associated with injury risk in the final model: passing the 2.4 km timed run and Y Balance Test average normalized posterolateral reach for the right limb. This model accurately predicted 60.9% of recruits with 36 correctly assigned as not injured and 87 correctly assigned as injured.

Conclusions: This study identified that 2 physical performance characteristics were associated with lower limb injury in New Zealand Army recruits commencing basic training; not passing the entry 2.4 km timed run, and low right posterolateral Y Balance Test score for lower limb dynamic neuromuscular control. These findings suggest that physical performance screening may be used to identify recruits at high risk of injury entering training so that mitigation measures could be implemented to lower future injury risk.